Step Into My Office: What Really Happens in Sex Therapy

Behind the doors of a sex therapist, clients seek understanding, acceptance, and answers. But how can mental health professionals help their clients achieve these goals? Dr. Stephanie Buehler, a licensed psychologist, sex therapist and a recognized author, invites you to "Step Into My Office" with monthly sidebars taken from her own experience.

One of the things I treasure most about the mental health profession is its optimism and emphasis on growth and change. When it comes to sexuality, we have the ability to adopt new beliefs, modify our role with clients, and change the rules about talking about sex in the therapy room.

These are requirements for becoming competent in treating clients’ sexual concerns. For all the reasons that therapists avoid the topic of sex in the first place, countertransference—in the form of anxiety, embarrassment, or moral judgment—may cloud potential solutions. For example, consider what a newly minted therapist might think if presented with the following situation:

In the intake call, Julian, age 68, described having a difficult time with delayed ejaculation, and the therapist assumed he meant with his wife. Thus, the therapist felt shocked when Julian revealed that he was having sex with massage therapists in order to resolve the problem he was having with his wife. Knowing that such activity was illegal and, in her eyes, immoral, the therapist choked and muttered some thoughts about aging and sexuality, including the bias that sexuality activity among elderly people is unseemly. Julian left the office without any help for the frustrating situation with his wife.

Cases such as this often occur in the context of problematic relationships, so it is helpful to have a seasoned and objective supervisor or consultant for guidance and to examine the source of negative countertransference. Supervisors and consultants can be found in various ways. One way is to inquire in one’s local professional organizations regarding experts in sexuality who might be available.